HESI RN MEDSURG V2 MULTIPLE-CHOICE, CLINICAL SCENARIOS
AND SET 1 EXAM QUESTIONS WITH ANSWERS AND EXPLANATIONS
1. A registered nurse is assessing an adult medical-surgical client. A paced client reports dizziness and
telemetry shows pacing spikes not followed by QRS complexes. Which condition best explains these
findings?
A. Permanent pacemaker malfunction
B. Acute coronary syndrome
C. Chronic venous insufficiency
D. Deep vein thrombosis
Correct Answer: A. Permanent pacemaker malfunction
Rationale: The assessment pattern is most consistent with Permanent pacemaker malfunction. Recognizing the
syndrome promptly is important because management priorities and complication surveillance depend on the
underlying pathophysiology.
2. A registered nurse is assessing an adult medical-surgical client. A client with a tracheostomy becomes
restless, has noisy respirations, falling oxygen saturation, and difficulty passing a suction catheter. Which
interpretation is most consistent with this presentation?
A. Pleural effusion requiring thoracentesis
B. Tracheostomy obstruction
C. Pulmonary tuberculosis
D. Chest tube air leak
Correct Answer: B. Tracheostomy obstruction
Rationale: The assessment pattern is most consistent with Tracheostomy obstruction. Recognizing the syndrome
promptly is important because management priorities and complication surveillance depend on the underlying
pathophysiology.
3. A registered nurse is assessing an adult medical-surgical client. A client has crushing substernal chest
pressure radiating to the left arm with diaphoresis and new ST-segment elevation. The nurse should
suspect which disorder?
A. Pericardial tamponade
B. Atrial fibrillation with rapid ventricular response
C. Acute coronary syndrome
D. Chronic venous insufficiency
Correct Answer: C. Acute coronary syndrome
Rationale: The assessment pattern is most consistent with Acute coronary syndrome. Recognizing the syndrome
promptly is important because management priorities and complication surveillance depend on the underlying
pathophysiology.
4. A registered nurse is assessing an adult medical-surgical client. A client with COPD has increased
dyspnea, wheezing, and increased sputum volume with falling oxygen saturation. Which diagnosis is the
priority concern based on this pattern?
A. Tension pneumothorax
B. COPD exacerbation
C. Obstructive sleep apnea
D. Tracheostomy obstruction
Correct Answer: B. COPD exacerbation
Rationale: The assessment pattern is most consistent with COPD exacerbation. Recognizing the syndrome
promptly is important because management priorities and complication surveillance depend on the underlying
pathophysiology.
5. A registered nurse is assessing an adult medical-surgical client. A client develops sudden severe tearing
chest pain radiating to the back with unequal arm blood pressures. Which clinical problem best matches
the assessment data?
A. Abdominal aortic aneurysm rupture
B. Cardiogenic shock
C. Acute arterial occlusion
,D. Aortic dissection
Correct Answer: D. Aortic dissection
Rationale: The assessment pattern is most consistent with Aortic dissection. Recognizing the syndrome promptly
is important because management priorities and complication surveillance depend on the underlying
pathophysiology.
6. A registered nurse is assessing an adult medical-surgical client. An older adult with type 2 diabetes has
profound dehydration, neurologic changes, very high glucose, and high serum osmolality with minimal
ketosis. Which condition best explains these findings?
A. Severe hypoglycemia
B. Hyperosmolar hyperglycemic state
C. Thyroid storm
D. Myxedema coma
Correct Answer: B. Hyperosmolar hyperglycemic state
Rationale: The assessment pattern is most consistent with Hyperosmolar hyperglycemic state. Recognizing the
syndrome promptly is important because management priorities and complication surveillance depend on the
underlying pathophysiology.
7. A registered nurse is assessing an adult medical-surgical client. A client has orthopnea, bibasilar
crackles, elevated jugular venous pressure, and rapid weight gain. Which interpretation is most consistent
with this presentation?
A. Hypertensive emergency
B. Pericardial tamponade
C. Peripheral arterial disease
D. Acute decompensated heart failure
Correct Answer: D. Acute decompensated heart failure
Rationale: The assessment pattern is most consistent with Acute decompensated heart failure. Recognizing the
syndrome promptly is important because management priorities and complication surveillance depend on the
underlying pathophysiology.
8. A registered nurse is assessing an adult medical-surgical client. A client has severe dyspnea, diffuse
crackles, orthopnea, and pink frothy sputum. The nurse should suspect which disorder?
A. Community-acquired pneumonia
B. Acute cardiogenic pulmonary edema
C. COPD exacerbation
D. Pulmonary tuberculosis
Correct Answer: B. Acute cardiogenic pulmonary edema
Rationale: The assessment pattern is most consistent with Acute cardiogenic pulmonary edema. Recognizing the
syndrome promptly is important because management priorities and complication surveillance depend on the
underlying pathophysiology.
9. A registered nurse is assessing an adult medical-surgical client. A client has hematemesis, melena,
orthostatic hypotension, and falling hemoglobin. Which diagnosis is the priority concern based on this
pattern?
A. Upper gastrointestinal bleeding
B. Acute diverticulitis with perforation risk
C. Acute cholecystitis
D. Acute pancreatitis
Correct Answer: A. Upper gastrointestinal bleeding
Rationale: The assessment pattern is most consistent with Upper gastrointestinal bleeding. Recognizing the
syndrome promptly is important because management priorities and complication surveillance depend on the
underlying pathophysiology.
10. A registered nurse is assessing an adult medical-surgical client. A client has chronic cough, weight loss,
night sweats, hemoptysis, and an upper-lobe cavitary lesion. Which clinical problem best matches the
assessment data?
A. Pulmonary tuberculosis
B. Pulmonary embolism
C. Severe asthma exacerbation
, D. COPD exacerbation
Correct Answer: A. Pulmonary tuberculosis
Rationale: The assessment pattern is most consistent with Pulmonary tuberculosis. Recognizing the syndrome
promptly is important because management priorities and complication surveillance depend on the underlying
pathophysiology.
11. A registered nurse is assessing an adult medical-surgical client. A client develops hypotension, jugular
venous distention, muffled heart sounds, and worsening dyspnea. Which condition best explains these
findings?
A. Hypertensive emergency
B. Peripheral arterial disease
C. Pericardial tamponade
D. Acute coronary syndrome
Correct Answer: C. Pericardial tamponade
Rationale: The assessment pattern is most consistent with Pericardial tamponade. Recognizing the syndrome
promptly is important because management priorities and complication surveillance depend on the underlying
pathophysiology.
12. A registered nurse is assessing an adult medical-surgical client. A client has sudden unilateral
weakness, facial droop, and aphasia with a known last-well time 45 minutes ago. Which interpretation is
most consistent with this presentation?
A. Intracerebral hemorrhage
B. Status epilepticus
C. Acute ischemic stroke
D. Increased intracranial pressure
Correct Answer: C. Acute ischemic stroke
Rationale: The assessment pattern is most consistent with Acute ischemic stroke. Recognizing the syndrome
promptly is important because management priorities and complication surveillance depend on the underlying
pathophysiology.
13. A registered nurse is assessing an adult medical-surgical client. A client has severe colicky flank pain
radiating to the groin, hematuria, and hydronephrosis. The nurse should suspect which disorder?
A. Hemodialysis access dysfunction
B. Acute glomerulonephritis
C. Continuous bladder irrigation after TURP
D. Ureteral stone with obstruction
Correct Answer: D. Ureteral stone with obstruction
Rationale: The assessment pattern is most consistent with Ureteral stone with obstruction. Recognizing the
syndrome promptly is important because management priorities and complication surveillance depend on the
underlying pathophysiology.
14. A registered nurse is assessing an adult medical-surgical client. A client has migrating
periumbilical-to-right-lower-quadrant pain, anorexia, nausea, and localized tenderness. Which diagnosis is
the priority concern based on this pattern?
A. Acute diverticulitis with perforation risk
B. Acute appendicitis
C. Hepatic encephalopathy
D. Acute pancreatitis
Correct Answer: B. Acute appendicitis
Rationale: The assessment pattern is most consistent with Acute appendicitis. Recognizing the syndrome
promptly is important because management priorities and complication surveillance depend on the underlying
pathophysiology.
15. A registered nurse is assessing an adult medical-surgical client. An older adult with hypothyroidism
becomes hypothermic, bradycardic, hypotensive, hyponatremic, and progressively obtunded. Which
clinical problem best matches the assessment data?
A. Adrenal crisis
B. Cushing syndrome
C. Myxedema coma
AND SET 1 EXAM QUESTIONS WITH ANSWERS AND EXPLANATIONS
1. A registered nurse is assessing an adult medical-surgical client. A paced client reports dizziness and
telemetry shows pacing spikes not followed by QRS complexes. Which condition best explains these
findings?
A. Permanent pacemaker malfunction
B. Acute coronary syndrome
C. Chronic venous insufficiency
D. Deep vein thrombosis
Correct Answer: A. Permanent pacemaker malfunction
Rationale: The assessment pattern is most consistent with Permanent pacemaker malfunction. Recognizing the
syndrome promptly is important because management priorities and complication surveillance depend on the
underlying pathophysiology.
2. A registered nurse is assessing an adult medical-surgical client. A client with a tracheostomy becomes
restless, has noisy respirations, falling oxygen saturation, and difficulty passing a suction catheter. Which
interpretation is most consistent with this presentation?
A. Pleural effusion requiring thoracentesis
B. Tracheostomy obstruction
C. Pulmonary tuberculosis
D. Chest tube air leak
Correct Answer: B. Tracheostomy obstruction
Rationale: The assessment pattern is most consistent with Tracheostomy obstruction. Recognizing the syndrome
promptly is important because management priorities and complication surveillance depend on the underlying
pathophysiology.
3. A registered nurse is assessing an adult medical-surgical client. A client has crushing substernal chest
pressure radiating to the left arm with diaphoresis and new ST-segment elevation. The nurse should
suspect which disorder?
A. Pericardial tamponade
B. Atrial fibrillation with rapid ventricular response
C. Acute coronary syndrome
D. Chronic venous insufficiency
Correct Answer: C. Acute coronary syndrome
Rationale: The assessment pattern is most consistent with Acute coronary syndrome. Recognizing the syndrome
promptly is important because management priorities and complication surveillance depend on the underlying
pathophysiology.
4. A registered nurse is assessing an adult medical-surgical client. A client with COPD has increased
dyspnea, wheezing, and increased sputum volume with falling oxygen saturation. Which diagnosis is the
priority concern based on this pattern?
A. Tension pneumothorax
B. COPD exacerbation
C. Obstructive sleep apnea
D. Tracheostomy obstruction
Correct Answer: B. COPD exacerbation
Rationale: The assessment pattern is most consistent with COPD exacerbation. Recognizing the syndrome
promptly is important because management priorities and complication surveillance depend on the underlying
pathophysiology.
5. A registered nurse is assessing an adult medical-surgical client. A client develops sudden severe tearing
chest pain radiating to the back with unequal arm blood pressures. Which clinical problem best matches
the assessment data?
A. Abdominal aortic aneurysm rupture
B. Cardiogenic shock
C. Acute arterial occlusion
,D. Aortic dissection
Correct Answer: D. Aortic dissection
Rationale: The assessment pattern is most consistent with Aortic dissection. Recognizing the syndrome promptly
is important because management priorities and complication surveillance depend on the underlying
pathophysiology.
6. A registered nurse is assessing an adult medical-surgical client. An older adult with type 2 diabetes has
profound dehydration, neurologic changes, very high glucose, and high serum osmolality with minimal
ketosis. Which condition best explains these findings?
A. Severe hypoglycemia
B. Hyperosmolar hyperglycemic state
C. Thyroid storm
D. Myxedema coma
Correct Answer: B. Hyperosmolar hyperglycemic state
Rationale: The assessment pattern is most consistent with Hyperosmolar hyperglycemic state. Recognizing the
syndrome promptly is important because management priorities and complication surveillance depend on the
underlying pathophysiology.
7. A registered nurse is assessing an adult medical-surgical client. A client has orthopnea, bibasilar
crackles, elevated jugular venous pressure, and rapid weight gain. Which interpretation is most consistent
with this presentation?
A. Hypertensive emergency
B. Pericardial tamponade
C. Peripheral arterial disease
D. Acute decompensated heart failure
Correct Answer: D. Acute decompensated heart failure
Rationale: The assessment pattern is most consistent with Acute decompensated heart failure. Recognizing the
syndrome promptly is important because management priorities and complication surveillance depend on the
underlying pathophysiology.
8. A registered nurse is assessing an adult medical-surgical client. A client has severe dyspnea, diffuse
crackles, orthopnea, and pink frothy sputum. The nurse should suspect which disorder?
A. Community-acquired pneumonia
B. Acute cardiogenic pulmonary edema
C. COPD exacerbation
D. Pulmonary tuberculosis
Correct Answer: B. Acute cardiogenic pulmonary edema
Rationale: The assessment pattern is most consistent with Acute cardiogenic pulmonary edema. Recognizing the
syndrome promptly is important because management priorities and complication surveillance depend on the
underlying pathophysiology.
9. A registered nurse is assessing an adult medical-surgical client. A client has hematemesis, melena,
orthostatic hypotension, and falling hemoglobin. Which diagnosis is the priority concern based on this
pattern?
A. Upper gastrointestinal bleeding
B. Acute diverticulitis with perforation risk
C. Acute cholecystitis
D. Acute pancreatitis
Correct Answer: A. Upper gastrointestinal bleeding
Rationale: The assessment pattern is most consistent with Upper gastrointestinal bleeding. Recognizing the
syndrome promptly is important because management priorities and complication surveillance depend on the
underlying pathophysiology.
10. A registered nurse is assessing an adult medical-surgical client. A client has chronic cough, weight loss,
night sweats, hemoptysis, and an upper-lobe cavitary lesion. Which clinical problem best matches the
assessment data?
A. Pulmonary tuberculosis
B. Pulmonary embolism
C. Severe asthma exacerbation
, D. COPD exacerbation
Correct Answer: A. Pulmonary tuberculosis
Rationale: The assessment pattern is most consistent with Pulmonary tuberculosis. Recognizing the syndrome
promptly is important because management priorities and complication surveillance depend on the underlying
pathophysiology.
11. A registered nurse is assessing an adult medical-surgical client. A client develops hypotension, jugular
venous distention, muffled heart sounds, and worsening dyspnea. Which condition best explains these
findings?
A. Hypertensive emergency
B. Peripheral arterial disease
C. Pericardial tamponade
D. Acute coronary syndrome
Correct Answer: C. Pericardial tamponade
Rationale: The assessment pattern is most consistent with Pericardial tamponade. Recognizing the syndrome
promptly is important because management priorities and complication surveillance depend on the underlying
pathophysiology.
12. A registered nurse is assessing an adult medical-surgical client. A client has sudden unilateral
weakness, facial droop, and aphasia with a known last-well time 45 minutes ago. Which interpretation is
most consistent with this presentation?
A. Intracerebral hemorrhage
B. Status epilepticus
C. Acute ischemic stroke
D. Increased intracranial pressure
Correct Answer: C. Acute ischemic stroke
Rationale: The assessment pattern is most consistent with Acute ischemic stroke. Recognizing the syndrome
promptly is important because management priorities and complication surveillance depend on the underlying
pathophysiology.
13. A registered nurse is assessing an adult medical-surgical client. A client has severe colicky flank pain
radiating to the groin, hematuria, and hydronephrosis. The nurse should suspect which disorder?
A. Hemodialysis access dysfunction
B. Acute glomerulonephritis
C. Continuous bladder irrigation after TURP
D. Ureteral stone with obstruction
Correct Answer: D. Ureteral stone with obstruction
Rationale: The assessment pattern is most consistent with Ureteral stone with obstruction. Recognizing the
syndrome promptly is important because management priorities and complication surveillance depend on the
underlying pathophysiology.
14. A registered nurse is assessing an adult medical-surgical client. A client has migrating
periumbilical-to-right-lower-quadrant pain, anorexia, nausea, and localized tenderness. Which diagnosis is
the priority concern based on this pattern?
A. Acute diverticulitis with perforation risk
B. Acute appendicitis
C. Hepatic encephalopathy
D. Acute pancreatitis
Correct Answer: B. Acute appendicitis
Rationale: The assessment pattern is most consistent with Acute appendicitis. Recognizing the syndrome
promptly is important because management priorities and complication surveillance depend on the underlying
pathophysiology.
15. A registered nurse is assessing an adult medical-surgical client. An older adult with hypothyroidism
becomes hypothermic, bradycardic, hypotensive, hyponatremic, and progressively obtunded. Which
clinical problem best matches the assessment data?
A. Adrenal crisis
B. Cushing syndrome
C. Myxedema coma
